Benefit Information

If English is not your first language, do you need help communicating with us or understanding our materials?

GOBHI wants to help you understand and use your health care benefits. We have staff who speak more than one language. When you call us, you can ask to talk to someone in the language you speak. We also can provide an interpreter to help you. We have translation services available. All these services are free. There is no cost. If you need help understanding your benefits or how to get care and services please call Member Services at 1-800-493-0040.

Do you need information in an alternative format, such as braille, larger font, audio CD, etc.?

To ensure that our information is accessible to all, we are happy to provide material both on the website and Member Handbook in alternate formats to no cost to you. To get material in an alternate format please call Member Services at 1-800-493-0040

How can I find out about the professional qualifications of my provider?

GOBHI has a large network of different types of behavioral health care practitioners to provide you with care and service. There is information about these practitioners in our directory. We tell you the name, address, telephone number and the type of license each practitioner has in our network. If you would like more information about the professional qualifications of our practitioners, please call Member Services at 1-800-493-0040. Member Services will tell you the medical school that a doctor attended, residency completed, and their board certification status. Member services can also tell you where all licensed behavioral health practitioners went to school and if they trained and are certified in any specialized behavioral health service.

What is my cost for services?

If you are enrolled in Medicaid and meet the criteria for mental health and substance use services, all approved services are provided without cost to you. Services must be approved before you receive them to avoid charges.

What do I do if I receive a bill?

When you receive covered services from providers in the GOBHI network, you will not receive a bill. You will not need to submit claim forms when you receive covered services from GOBHI providers.

How do I get care if I am not in my home area?

Emergency care is covered while you are away from home. Do not use the emergency room for non-emergency care. If possible, wait until you return to the GOBHI service area to receive care.

If you receive emergency care or a hospital stay, contact your local GOBHI Provider as soon as you are able. You may have to pay for emergency services if it is determined not to be medically necessary. The Oregon Health Plan does not cover services outside the U.S.

Can I get care from providers that are not in the GOBHI Network?

GOBHI has a network of participating providers. These providers have contracted with us to treat our Members. There are many different types of providers in our network so that all of your health care needs can be met.

Your provider may refer you to a provider that is not in GOBHI’s Network. When this happens, your provider will get approval from us before you receive services. We will pay for the services we have approved. If you seek care and services from a provider who is not in GOBHI’s Network, without a referral, you will have to pay for those services.

Submitting a Complaint

GOBHI is committed to providing you the best possible health care experience. We want you to be happy with our services and with the care that you receive. If you are not satisfied, please tell us. Any time you are dissatisfied we want to know. Call, write, or fax us your complaint.

If you need language assistance to help you file a complaint, let us know. We will provide language assistance at no cost to you. We have bilingual staff and an interpreter service available for the entire process. Upon request, we can provide oral interpretation of documents written in English into your preferred language or translation of written documents into your preferred language. Finding the best way to resolve your complaint is an important part of our quality improvement program.

We take all complaints very seriously and will investigate the issues thoroughly. If you make a complaint by telephone, the individual receiving the complaint will make every effort to resolve the complaint to your satisfaction at the time of the telephone call. In some cases we cannot resolve a complaint with one telephone call. If we cannot provide resolution during the call, we will investigate the issues and notify you of our decision.

We will notify you of our proposed resolution within 30 calendar days. In some cases our investigation may take longer. If this happens we will notify you and tell you the reason for the delay and the anticipated decision date. If your complaint is urgent, we will give you our decision within 72 hours.

When we notify you about the proposed resolution to the complaint, we will tell you if our decision may be appealed and about how you may appeal the decision.

Asking Us to Reconsider a Decision

We understand that you may disagree with a decision that we make. We make decisions about resolving complaints and we make decisions about authorizing coverage for care or treatment. When we make these decisions, we make every effort to avoid disagreements. If you do not agree with our decision, you may appeal. We will tell you about how to appeal decisions we make as part of the resolution process. This includes how to appeal our decisions that might have a negative impact on your coverage or benefits or our relationship. We will also help you with the appeal process. An appeal is your request for us to change our decision about a complaint resolution or coverage for care or treatment issue. You may request an administrative hearing to GOBHI or an independent external review directly from Oregon’s Health Systems Division.

When GOBHI makes decisions about complaints or authorizing coverage for care or treatment, we will tell you about how you can appeal the decision. If you are unhappy with the decision, you may file an appeal. Call, write, or fax us your appeal.

If you need language assistance to help you file an appeal, let us know. We will provide language assistance at no cost to you. We have bilingual staff and an interpreter service available for the entire process. Upon request, we can provide oral interpretation of documents written in English into your preferred language or translation of written documents into your preferred language. Finding the best way to resolve your appeal is an important part of our quality improvement program.

We will investigate the issues thoroughly. The staff involved in the investigation will not be the same as the individual(s) who made the first decision.

We propose resolutions to routine appeals within 16 calendar days and notify you of the decision. We propose resolutions to clinically urgent appeals within 72 hours and notify you of the decision.

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. It is also available in large print, braille, CD tape and other formats and languages upon request.

A Copy of Your Records

You can have a copy of your behavioral health records. Your Provider has most of your records, so you can ask them for a copy. They may charge a reasonable fee for copies. You can ask us for a copy of the records we have. We will charge you a reasonable fee for the copies. You can have a copy of your mental health records unless your provider thinks this could cause serious problems.

GOBHI is committed to improving the health status of the population it serves and, by extension, the community. The GOBHI quality improvement program is based on a philosophy that emphasizes a systematic, organization-wide perspective that involves everyone. It is focused on achieving satisfaction for both internal and external customers and improving Member outcomes within an organizational environment that seeks continuous improvement of systems and processes.